An Unusual Cause of Chronic Headache in an Adolescent Boy: A Case Report

2019 ◽  
Vol 50 (06) ◽  
pp. 395-399
Author(s):  
Sangeetha Yoganathan ◽  
Ramamani Mariappan ◽  
Sniya Valsa Sudhakar ◽  
Sunithi Elizabeth Mani ◽  
Vivek Mathew ◽  
...  
Keyword(s):  
Spontaneous Intracranial Hypotension ◽  
Brain Magnetic Resonance Imaging ◽  
Csf Leak ◽  
Recurrent Headache ◽  
Blood Patch ◽  
History Of ◽  
Daily Headache ◽  
Magnetic Resonance Imaging Mri ◽  
Glue Injection ◽  
The Brain

AbstractSpontaneous intracranial hypotension (SIH) is an under-diagnosed cause of headache in children and adolescents. SIH results from cerebrospinal fluid (CSF) leak due to breach in the dura mater and the etiology for dural breach is often diverse. We report an adolescent boy who presented with chronic episodic headache that later progressed to daily headache. There was a typical history of worsening of headache on upright position and relief of headache on lying down. He was treated with migraine prophylaxis in another hospital but there was no response. Marfanoid features and brisk deep tendon reflexes were observed on clinical examination. Brain magnetic resonance imaging (MRI) revealed sagging of the brain stem, pachymeningeal enhancement, and tonsillar herniation. MRI of spine myelogram confirmed multiple levels of CSF leak. He was initially managed with supportive measures and fluoroscopic-guided fibrin glue injection. Although child remained symptom-free for the next 6 months, he again developed headache. MRI and computed tomography spine myelogram revealed a meningeal diverticulum in the lumbar spine. He was managed with an autologous epidural blood patch and he has been well since then. In this report, we highlight the clinical and radiological pointers to the presence of SIH in children with recurrent headache.

scholarly journals Spontaneous C1-2 CSF Leak Treated with High Cervical Epidural Blood Patch

2008 ◽  
Vol 35 (1) ◽  
pp. 102-105 ◽  
Author(s):  
Philip WH Peng ◽  
Richard Farb
Keyword(s):  
Epidural Blood Patch ◽  
Spontaneous Intracranial Hypotension ◽  
Memory Loss ◽  
Csf Leak ◽  
Cerebellar Tonsil ◽  
Iodinated Contrast ◽  
Blood Patch ◽  
Magnetic Resonance Imaging Mri ◽  
Fluid Collections ◽  
High Cervical

Spontaneous intracranial hypotension (SIH) is a condition caused by spontaneous spinal cerebrospinal fluid (CSF) leaks. Clinically, it is characterized by orthostatic headache and may respond well to epidural blood patch. Other neurological presentations of SIH include diplopia, memory loss, hearing deficits, Parkinsonism, ataxia, obtundation and even coma.Magnetic resonance imaging (MRI) is crucial in the diagnosis of this condition. Typical radiological features include diffuse pachymeningeal enhancement, descent of the cerebellar tonsil, a decrease in the size of prepontine and perichiasmatic cisterns, and subdural fluid collections. However, radiological imaging such as radionuclide cisternography or spinal MRI are not reliable in detecting the site of leakage. Myelography with iodinated contrast followed by thin-cut computed tomography (CT) or MRI of the entire spine has been shown as the technique of choice in defining the location of the CSF leak.

scholarly journals Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Inês Correia ◽  
Inês Brás Marques ◽  
Rogério Ferreira ◽  
Miguel Cordeiro ◽  
Lívia Sousa
Keyword(s):  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Spontaneous Intracranial Hypotension ◽  
Complete Recovery ◽  
Csf Leak ◽  
Ct Guided ◽  
Blood Patch ◽  
History Of ◽  
Persistent Headache ◽  
Csf Leaks

Spontaneous intracranial hypotension (SIH) is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF) leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery.

scholarly journals Spontaneous Intracranial Hypotension and the durability of Epidural Blood Patch

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Ali Hazama ◽  
Lori John ◽  
Alexander E Braley ◽  
Lawrence S Chin ◽  
Satish Krishnamurthy
Keyword(s):  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Symptomatic Relief ◽  
Brain Mri ◽  
Spontaneous Intracranial Hypotension ◽  
Brain Magnetic Resonance Imaging ◽  
Definitive Treatment ◽  
Csf Leak ◽  
Persistent Symptoms ◽  
Blood Patch

Abstract INTRODUCTION Spontaneous Intracranial Hypotension (SIH) remains a rare and difficult clinical entity to diagnose and treat. Epidural blood patch (EBP) is the mainstay definitive treatment for refractory cases and has mixed efficacy. We sought to evaluate recent efficacy and outcomes of EBP for SIH at our institution. We also sought to explore the viability of repeat blood patches for patients whose symptoms persisted or recurred. METHODS A total of 23 patients (14 women, 9 men, mean age 49) were seen and treated for SIH between Summer 2009 and Spring 2018. All patients underwent brain magnetic resonance imaging (MRI) with and without gadolinium contrast and T2-weighted spine MRI. Targeted EBPs were placed at 1-2 vertebral levels below identified or suspected areas of leak. Patients were seen within a week following initial EBP and repeat EBP was offered to patients with persistent symptoms. Patients were followed if symptoms persisted or for 6 mo following clinical relief of symptoms. RESULTS 22/23 (95.7%) patients presented with complaints of orthostatic headache, 3 (13%) patients presented with altered mental status (AMS) or focal neurologic deficit. Brain MRI demonstrated pachymeningial enhancement in 16/23 (69.6%) patients, and 5/23 (21.7%) patients had subdural hematoma (SDH) present. Dural leaks were successfully identified in 18/23 (78.3%) patients. 12/23 (52.2%) patients had symptomatic relief with initial EBP, 5/23 (21.7%) patients received repeat EBPs for persistent symptoms will all achieving relief after repeat EBP. About 5/12 (41.7%) patients had recurrent symptoms after initial relief with EBP, and 4/5 (80%) were successfully treated with a second EBP. The mean initial EBP volume and number of EBPs per patient was 21.7 mL. In total, 18/23 (78.2%) patients are currently asymptomatic with regards to their SIH. Mean follow-up in this cohort was 2.6 yr. CONCLUSION EBP is a viable option for the treatment of SIH caused by CSF leak. Repeat epidural blood patch is reasonable in cases of recurrent symptoms.

scholarly journals Ehlers Danlos, POTS, and Occult Cerebrospinal Fluid Leak: A Case Report

2017 ◽  
Vol 2 (2) ◽  
Keyword(s):  
Cerebrospinal Fluid ◽  
Spontaneous Intracranial Hypotension ◽  
Cerebrospinal Fluid Leak ◽  
Csf Leak ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Mri Imaging ◽  
Epidural Blood Patching ◽  
Blood Patch ◽  
History Of ◽  
Fluid Leak

Ehlers Danlos syndromes (EDS) are associated with spontaneous intracranial hypotension (SIH) and postural orthostatic tachycardia syndrome (POTS). We hypothesized that some POTS patients might in fact have occult SIH due to unappreciated EDS. We describe a 26-year-old female with a history of POTS and headache who presented to us with negative imaging for cerebrospinal fluid leak (CSF). Upon examination with clinical evidence of EDS and supportive history, we performed an epidural blood patch despite repeat imaging evidence negative for CSF leak resulting in resolution of the patient’s POTS, headache, and cognitive symptoms. Patients with POTS and connective tissue disorders associated with dural weakness may be suffering from occult chronic CSF leaks. MRI imaging may be falsely reassuring and dissuade clinicians from performing epidural blood patching among patients who can be cured.

An Uncommon Manifestation of a Common Tropical Disease: Disseminated Cysticercosis

2012 ◽  
Vol 25 (2) ◽  
pp. 200-205 ◽  
Author(s):  
K. Gangadhar ◽  
D. Santhosh
Keyword(s):  
Skeletal Muscles ◽  
Brain Magnetic Resonance Imaging ◽  
The Body ◽  
Whole Body ◽  
Resonance Imaging ◽  
Rare Form ◽  
Whole Body Mri ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

Disseminated cysticercosis is a rare form of cysticercosis in which the cysticerci spread throughout the body. We describe the case of a seven-year-old child with disseminated cysticercosis. He presented with a one month history of swelling of the whole body, unable to walk for one month and swelling of both eyes for 20 days. After extensive investigation from superficial musculoskeletal ultrasound B-scan of eye, brain computed tomography, brain magnetic resonance imaging (MRI), whole body MRI and pathologic biopsy, the child was diagnosed as having cysticercosis involving the brain, retina and skeletal muscles throughout the whole body.

scholarly journals 690 Intracranial Hypotension Due to CSF Leak Secondary to Ventral Thoracic Osteophyte Complex: Resolution After Transdural Thoracic Discectomy and Dural Repair

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
B Kewlani ◽  
I Hussain ◽  
J Greenfield
Keyword(s):  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Bed Rest ◽  
Structural Defects ◽  
Csf Leak ◽  
History Of ◽  
Surgical Cure ◽  
Thoracic Discectomy ◽  
Herniated Discs

Abstract The hallmark symptom of spontaneous intracranial hypotension (SIH) is orthostatic headaches which manifests secondary to cerebrospinal fluid (CSF) hypovolaemia. Well-recognised aetiologies include trauma which includes procedures such as lumbar punctures and spinal surgery. More recently, structural defects such as bony osteophytes and calcified or herniated discs have been attributed to mechanically compromising dural integrity consequently resulting in CSF leak and symptom manifestation. A thorough literature review noted only a handful of such cases. We report the case of a thirty-two-year-old Asian female who presented with a one-month history of new-onset progressively worsening orthostatic headaches. Workup included MRI of the thoracic spine which revealed an epidural collection of CSF consequently prompting a dynamic CT-myelogram of the spine which not only helped to confirm severe cerebral hypotension but also suggested the underlying cause as being a dorsally projecting osteophyte-complex at level T2-3. Conservative and medical management including bed rest, analgesia, mechanical compression, and epidural blood patches failed to alleviate symptoms and a permanent surgical cure was eventually sought. The surgery involved T2-T3 laminectomy and osteophytectomy and at a 3-month follow-up, complete resolution of symptoms was noted.

De novo convulsive status epilepticus in patients with multiple sclerosis treated with dalfampridine

2018 ◽  
Vol 25 (4) ◽  
pp. 618-621 ◽  
Author(s):  
Emilie Panicucci ◽  
Mikael Cohen ◽  
Veronique Bourg ◽  
Fanny Rocher ◽  
Pierre Thomas ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Status Epilepticus ◽  
De Novo ◽  
Case Reports ◽  
Brain Magnetic Resonance Imaging ◽  
Convulsive Status Epilepticus ◽  
Biological Tests ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
History Of Epilepsy

Background: Dalfampridine extended release (DAL) is a broad-spectrum voltage-gated potassium channel blocker that is indicated in multiple sclerosis to improve the nerve conduction of demyelinated axons. Seizures are a known side effect of DAL, which is contraindicated in patients with a history of epilepsy. Objective: Three cases of multiple sclerosis (MS) with de novo convulsive status epilepticus (CSE) probably related to dalfampridine administration are described. Methods: No patients had a history of seizures or renal impairment. Biological tests were normal. A brain magnetic resonance imaging (MRI) showed diffuse cortical and subcortical atrophy without active inflammatory lesions. Results: All three patients presented with CSE that was attributed to DAL and so was discontinued. Conclusion: These case reports illustrate that, aside from seizures, de novo CSE is a potential complication of MS patients treated with DAL.

scholarly journals Diagnosing RCVS Without the CV

2015 ◽  
Vol 6 (3) ◽  
pp. NP1-NP4 ◽  
Author(s):  
Nuri Jacoby ◽  
Ulrike Kaunzner ◽  
Marc Dinkin ◽  
Joseph Safdieh
Keyword(s):  
Magnetic Resonance ◽  
Resonance Imaging ◽  
Multiple Risk Factors ◽  
Mri Brain ◽  
Cerebral Vasoconstriction ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
Reversible Encephalopathy ◽  
Occipital Lobes ◽  
The Brain

This is a case of a 52-year-old man with a past medical history of 2 episodes of coital thunderclap headaches as well as recent cocaine, marijuana, and pseudoephedrine use, who presented with sudden, sharp, posterior headache associated with photophobia and phonophobia. His initial magnetic resonance imaging (MRI) of the brain, magnetic resonance angiography (MRA) of the head, and magnetic resonance venography (MRV) of the head were all normal as well as a normal lumbar puncture. Given the multiple risk factors for reversible cerebral vasoconstriction syndrome (RCVS), the patient was treated for suspected RCVS, despite the normal imaging. Repeat MRI brain 3 days after hospital admission demonstrated confluent white matter T2 hyperintensities most prominent in the occipital lobes, typical of posterior reversible encephalopathy syndrome (PRES). Repeat MRA of the head 1 day after discharge and 4 days after the abnormal MRI brain showed multisegment narrowing of multiple arteries. This case demonstrates that RCVS may present with PRES on MRI brain and also exemplifies the need to treat suspected RCVS even if imaging is normal, as abnormalities in both the MRI and the MRA may be delayed.

scholarly journals Idiopathic Hypertrophic Pachymeningitis Manifesting with Frontal Brain Edema

2001 ◽  
Vol 19 (3) ◽  
pp. 491-495
Author(s):  
Mário Emílio Teixeira Dourado Júnior ◽  
Ricardo Humberto de Miranda Félix ◽  
Marcos Dias Leão
Keyword(s):  
Dura Mater ◽  
Histopathological Study ◽  
Hypertrophic Pachymeningitis ◽  
Falx Cerebri ◽  
Additional Information ◽  
Frontal Brain ◽  
History Of ◽  
Cerebral Parenchyma ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain

Introduction. Hypertrophic pachymeningitis (HP) is a rare inflammatory disease that results in thickening of the dura mater. Atypically, it can progress to include the involvement of the cerebral parenchyma. Method. In this paper, we report the rare case of a 31-year-old man with a three-week history of headaches, seizures, impairments of cognitive function, and changes in behavior and mood. Magnetic resonance imaging (MRI) of the brain showed a thickening and an abnormal enhancement of the dura mater over the falx cerebri with extensions into the adjacent cranial base and with brain edemas in the frontal lobes. Histopathological study of meningeal and brain biopsies showed an inflammatory process that was compatible with HP. The results of an extensive laboratory investigation were unremarkable and did not provide additional information on the cause of the meningeal disease. The patient exhibited relapses despite immunosuppressive therapy. Conclusion. This case shows the challenges associated with the management of the disease and the importance of early diagnosis to avoid worsening of the condition and cerebral damage.

scholarly journals Disseminated Mycobacterium tuberculosis following renal transplant: A case report

Pneumologia ◽  
2021 ◽  
Vol 69 (3) ◽  
pp. 182-185
Author(s):  
Mahmoud Sadeghi-Haddad-Zavareh ◽  
Mohammad Reza Hasanjani Roushan ◽  
Zeinab Mohseni Afshar ◽  
Masomeh Bayani ◽  
Soheil Ebrahimpour ◽  
...  
Keyword(s):  
Case Report ◽  
Renal Transplant ◽  
Psoas Abscess ◽  
Miliary Tuberculosis ◽  
Caseous Necrosis ◽  
High Clinical Suspicion ◽  
History Of ◽  
Magnetic Resonance Imaging Mri ◽  
The Brain ◽  
Current Report

Abstract Miliary tuberculosis (TB) presents a major challenge following a renal transplant in humans. In the current report, we described a patient with disseminated TB following renal transplantation. The article presents the case of a 38-year-old man who presented an 8-month history of fever, chills, sweating, low-back pain and significant weight loss. Chest radiography and computed tomography (CT) scan showed miliary nodules distributed in the two lungs. The transbronchial lung biopsy revealed a granulomatous reaction with caseous necrosis. Magnetic resonance imaging (MRI) of the brain found multiple tuberculomas. Also, MRI of the lumbosacral was indicative of a psoas abscess. Therefore, miliary pulmonary, cerebral and spinal TB was confirmed. The patient was started on an anti-TB regimen and paravertebral aspiration was also done. The patient’s condition improved considerably. In conclusion, this case report can remind us of the importance of maintaining a high clinical suspicion and performing a thorough workup to establish a timely diagnosis and treatment of miliary TB.

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